Provider Demographics
NPI:1871803775
Name:HAMMOND BEAL, LISA JO (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JO
Last Name:HAMMOND BEAL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:JO
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:29 REGAL PL
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5431
Mailing Address - Country:US
Mailing Address - Phone:845-849-6625
Mailing Address - Fax:
Practice Address - Street 1:29 REGAL PL
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5431
Practice Address - Country:US
Practice Address - Phone:845-849-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist